Original Article

Initial Basal and Bolus Rates and Basal Rate Variability During Pump Treatment in Children and Adolescents

10.4274/jcrpe.galenos.2020.2020.0171

  • Günay Demir
  • Yasemin Atik Altınok
  • Samim Özen
  • Şükran Darcan
  • Damla Gökşen

Received Date: 03.09.2020 Accepted Date: 28.12.2020 J Clin Res Pediatr Endocrinol 0;0(0):0-0 [e-Pub] PMID: 33374094

Objective:

Pump-treated children with type 1 diabetes have widely differing basal insulin infusion profiles for specific periods of the day. The pattern of basal insulin requirements depends on the timing and magnitude of cortisol and growth hormone secretion within each age group. In adolescents and young adults, a decreased insulin sensitivity is seen, particularly in the early morning (dawn phenomenon) and of lesser extent, in the late afternoon (dusk phenomenon). Different approaches exist for the inititation of basal rates however, there is a lack of evidence-based recommendation, especially in young children. Usually the basal rates are set equally throughout day and night or the day is divided into tertiles. The aim of our study was to analyze the change of the initial equally distributed basal insulin rates over time of standart insulin pump therapy.

Methods:

A total of 154 children with T1D, aged between 0 and <21 yrs, from a single center were documented. Children with T1D were divided into five age groups, group 1; <5 yr (n = 36); group 2; 5 to 8 yrs (n =20); group 3; 8 to 15 yrs (n=74); group 4; 15 to18 yrs,(n = 19) group 5; >18 yrs, (n = 5). Distribution of hourly basal rates at the initiation of the pump and at the end of first year were evaluated.

Result:

Median age and diabetes duration was 14.46 (min:1.91/max:26.15) and 7.89 (±3.8) yrs (min:1.16/max:17.15) respectively. Forty-four percent were male, 56% were female. Mean total insulin dose/kg at the initiation and 1 st year of pump therapy was 0.86±0.23 U/kg and 0.78±0.19 U/kg in all participants respectively and differs in each age group (p<0.001; p<0.001). Mean daily basal rate/ kg showed substantial differences between the five groups (p<0.001). Circadian distribution of basal insulin differed markedly among the five age groups.

Conclusions:

At the initiation of the insulin pump therapy, circadian profiles by age group should be taken into account when initiating CSII therapy in pediatric patients to optimize basal rate faster and easier.